Epidemic sweeping the city's addicts

90% of needle users in Baltimore infected with hepatitis C

July 05, 1999|By Jonathan Bor | Jonathan Bor,SUN STAFF

Overshadowed by AIDS, a silent epidemic of hepatitis C is sweeping through Baltimore's population of intravenous drug users -- threatening many with liver failure and cancer decades after they were first infected.

Recent studies by the Johns Hopkins School of Public Health show that well over 90 percent of the city's addicts are infected with the virus. The rate among young addicts who are less than five years into drug use is 58 percent -- stark evidence of how rapidly this virus is traveling among people who share needles. The rate among young addicts in Baltimore was higher than in four other cities surveyed.

"I don't think people fully appreciate how quickly hepatitis C can be transmitted after starting injection," said Dr. David Vlahov, a Hopkins epidemiologist who studies health trends among intravenous drug users. "If you've been injecting for more than a couple years, the chances are you are infected with hepatitis C."

The virus can lurk inside the body for 20 years before causing serious problems.

"They don't believe this could happen, that they could be sick and not know it," said Henry Russell, 45, a recovering addict with AIDS and hepatitis C who distributes anti-drug literature at busy drug corners in Baltimore. "It's a serious disease, but they don't want to think about a disease that can't be seen."

In a city that has an estimated 59,000 intravenous drug addicts, hepatitis C is likely to have an impact well into the 21st century. Although many of the infected are unlikely to get liver disease, those who do will require expensive drugs and hospital stays. Hepatitis C is already the leading reason for liver transplants.

Before 1989, when blood banks started screening for the virus, about 80,000 people a year became infected after receiving transfusions of tainted blood. Now, hepatitis C is spread primarily by addicts whose needle-sharing rituals also account for most HIV transmission in the United States. HIV, the human immunodeficiency virus, causes acquired immune deficiency syndrome.

All told, an estimated 4 million Americans are infected with hepatitis C, about 60 percent through intravenous drug use.

Dr. Richard Chaisson, a professor of infectious diseases at the Johns Hopkins School of Medicine, said he has seen AIDS patients make remarkable recoveries after taking protease inhibitors and other AIDS drugs, only to develop liver failure from hepatitis C.

"HIV makes the hepatitis C more severe, and the chance of developing liver failure increases rather dramatically," Chaisson said. Fewer than 10 percent of otherwise healthy people who have hepatitis C will get liver disease, he said, but the risk increases fivefold if a person has HIV as well.

In the study of young drug addicts, researchers found that 58 percent of addicts in Baltimore between ages 15 and 30 were infected, compared with an average of 39 percent in New York, Chicago, New Orleans and Los Angeles.

Of individual cities, New York had the second-highest rate -- 51 percent in Harlem, 48 percent on the Lower East Side -- and Chicago was next with 33 percent. In New Orleans, 28 percent were infected; in Los Angeles, 23 percent.

Dr. Steffanie Strathdee, a Hopkins epidemiologist who runs the study in Baltimore, said she was not surprised to find high rates in Baltimore, a city where HIV has long been a problem among needle-sharing addicts. But, she said, researchers here might have done a better job recruiting hard-core addicts into the study, magnifying the differences between this city and others.

"But it's not surprising that we started off in a worse place than other cities," she said. "Baltimore was one of the epicenters for injection drug use and HIV." Historically, addicts east of the Appalachians have been hit the hardest by AIDS, said Vlahov, possibly because the region's population density makes it easier for infection to spread.

Strathdee called for an expansion of Baltimore's needle exchange program, which has provided 2.5 million clean needles to 9,000 addicts over the past five years. She said efforts should be made to reach young addicts, who are less likely than older people to take advantage of the program.

Studies have found lower rates of HIV among addicts who show up regularly at needle-exchange vans.

So far, there is no cure for hepatitis C. Doctors use two drugs -- ribavirin and interferon -- but the drugs help only 40 percent of patients. Side effects are so severe that many patients stop taking them. And they are expensive, costing more than $1,300 a month. Even when the drugs help, there is no evidence their effects are lasting.

Henry Russell, who said he shot heroin for 21 years, takes interferon along with medications for high blood pressure, AIDS and infections that prey upon his weakened immune system. He also takes methadone for his drug habit and the male hormone, testosterone, to help him retain weight.

He walks with a serious limp -- the result of a degenerated hip that, according to doctors, was a byproduct of his drug use. So far, the drugs are holding his AIDS in check, and symptoms of hepatitis haven't surfaced, despite tests that showed abnormal liver function.

Of this, he is glad. But he worries about the others, speaking with evangelical fervor about the need to reach those who are hurting themselves as he once did.

"I got to the point where I had a crummy life and decided I was going to do for other people what I didn't do for myself," he said. "I don't want to get to the point where I constantly see people turn into skeletons. Hepatitis C can do that, just as AIDS can."